How common is alcohol misuse in Ireland?

Alcohol misuse is widespread in Ireland. According to a Health Research Board report the majority (56%) of Irish people drink in a harmful manner.Over half of Irish 16 year old children have ever been drunk and one in five is a weekly drinker.

Alcohol increases the risk of more than 60 medical conditions and alcohol misuse is a major risk factor for a range of life-threatening diseases such as:

Recommended amount of alcohol

The amount of alcohol contained in any alcoholic drink is measured in standard drinks. A standard drink is equivalent 10 grams of pure alcohol.

The recommended weekly low risk limits for alcohol consumption are:

no more than 17 standard drinks for men

no more than 11 standard drinks for women

If you regularly exceed the recommended weekly limits, you are putting your health at risk.

In addition, you should have at least two or more alcohol free days in a week, and you should avoid binge drinking (which is drinking more than five standards drinks in one setting)

The recommendation of the Chief Medical Officer is that pregnant women and women trying to conceive should avoid drinking alcohol.

Standard Drinks

A standard drink is equivalent to a half pint of beer,a small glass of wine or sherry or a pub serving of spirits.

Types of alcohol misuse

There are three main types of alcohol misuse:

hazardous drinking

harmful drinking

dependent drinking

Hazardous drinking

Hazardous drinking is defined as when a person drinks over the recommended weekly limit (17 standard drinks for men and 11 standard drinks for women).

It is also possible to drink hazardously by binge drinking, even if you stick within your weekly limit. Binge drinking is when you drink an excessive amount of alcohol in a short space of time - six or more standard drinks in a single session.

If you are drinking hazardously, you may not yet have any health problems directly related to alcohol, but you are increasing your risk of experiencing problems in the future.

taking part in risky or illegal behaviour when drunk - such as drink driving

Harmful drinking

Harmful drinking is defined as when a person drinks over the recommended weekly amount and has experienced health problems directly related to alcohol.

In some cases, these problems may be obvious, such as:

depression

alcohol-related accident

acute pancreatitis (inflammation of the pancreas)

Many of the health problems caused by harmful drinking do not cause any symptoms until they reach their most serious stages, such as:

high blood pressure

cirrhosis (scarring of the liver)

some types of cancer, such as mouth, liver, bowel and breast cancer

heart disease

So it can be easy to underestimate the levels of physical damage caused by harmful drinking.

Harmful drinking can also cause related social problems such as:

difficulties with your partner or spouse

difficulties with family and friends

problems at work or college

Dependent drinking

Alcohol is both physically and psychologically addictive and it is possible to become dependent on alcohol.

Dependent means that a person feels that they are unable to function without alcohol and the consumption of alcohol becomes an important - or sometimes the most important - factor in their life.

Depending on the level of dependence, a person can experience withdrawal symptoms if their supply of alcohol is suddenly stopped. Withdrawal symptoms can be both physical and psychological.

Physical withdrawal symptoms include:

hand tremors ('the shakes')

sweating

nausea

visual hallucinations (seeing things that are not actually real), and, in the most serious of cases

seizures (fits)

Psychological withdrawal symptoms include:

depression

anxiety

irritability

restlessness

insomnia

Moderately dependent drinkers do not usually experience withdrawal symptoms, or withdrawal symptoms are mild to moderate.

Severely dependent drinkers do experience withdrawal symptoms, which are usually severe. Most severely dependent drinkers fall into a pattern of 'relief drinking', where they drink to avoid or counter withdrawal symptoms.

Severely dependent drinkers usually have an extremely high tolerance to alcohol, and are able to drink amounts that would incapacitate or even kill most other people.

Tips

Replace some of your drinks with non-alcoholic or low alcohol drinks

If you drink mainly when you go out, try going out later or having your first drink later

If you drink mainly at home, trying buying non-alcoholic alternatives

Buy smaller glasses and watch how much you pour

If you use alcohol to ‘wind down’ after a hard day, find alternatives such as exercise classes or relaxation techniques

Avoid drinking on an empty stomach

Avoid mixing different alcoholic drinks

Keep a drinking diary

On a daily basis, make a note of:

all the alcoholic drinks you had

how many standard drinks you drank

what time you had them

where you were

This should give you a good idea of how much you're drinking, the situations in which you drink and where you could start to cut down

If you visit your GP because you are concerned about your drinking, or you come into contact with another health professional due to an alcohol-related injury or illness, it is likely that they will want to assess the extent and pattern of your alcohol use.

This is usually done by using a screening test that consists of a series of questions. It is important to be truthful when responding to the questions. Your GP and/or other health professionals are not trying to judge you, they are simply trying to ensure you receive the appropriate treatment.

Alcohol Use Disorders Identification Test (AUDIT)

One widely used screening test is the Alcohol Use Disorders Identification Test (AUDIT). The test is available online here.

Fast Alcohol Screening Test (FAST)

A simpler test that you can use to check if your drinking has reached hazardous levels is known as the Fast Alcohol Screening Test (FAST).

FAST consists of four questions, which are reproduced below.

1. How often do you drink six or more standard drinks on one occasion:

never - if this is your answer you can stop the test

less than monthly - score 1

monthly - score 2

weekly - score 3

daily or almost daily - score 4

2. How often during the last year have you been unable to remember what happened the night before because you had been drinking:

never - 0

less than monthly - 1

monthly - 2

weekly - 3

daily or almost daily - 4

3. How often during the past year have you failed to do what was normally expected of you because you had been drinking:

never - 0

less than monthly - 1

monthly - 2

weekly - 3

daily or almost daily - 4

4. In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested that you cut down:

no - 0

yes, on one occasion - 1

yes, on more than one occasion - 2

A FAST score of 3 or more would usually suggest that you are drinking at a hazardous level.

Alcohol is a powerful chemical that can have a wide range of effects. As alcohol can easily pass through the walls of human cells, once it is in your blood it can reach almost every part of the body, from your brain to your bones to your heart.

The effects of alcohol can be both short term and long term. Similarly, the risks of alcohol can also be both short and long term.

Short-term effects of alcohol

The short-term effects of alcohol are described below. This information is based on the assumption that you have a normal tolerance for alcohol. Dependent drinkers with a higher tolerance to alcohol can often drink much more without experiencing any noticeable effects.

1-2 standard drinks

After drinking 1-2 standard drinks of alcohol, your heart rate will speed up and your blood vessels will expand, giving you the warm, sociable 'up' and talkative feeling that is associated with moderate drinking.

3-5 standard drinks

After drinking 3-5 standard drinks of alcohol, your brain and nervous system will start to be affected. It will start to 'dampen' the part of your brain that is associated with decision making and judgement, making you more reckless and uninhibited.

The alcohol will also impair the cells in your nervous system, making you feel lightheaded while also adversely affecting your reaction time and co-ordination.

6-7 standard drinks

After drinking 6-7 standard drinks of alcohol, your reaction times will be much slower, your speech will begin to slur, and your vision will begin to lose focus. Your liver (which the body uses to filter alcohol out of the body) will be unable to remove all of the alcohol overnight, so it is likely you will wake with a hangover.

8-10 standard drinks

After drinking 8-10 standard drinks of alcohol, your co-ordination will be seriously impaired, placing you at high risk of having an accident. The high levels of alcohol will have a depressant effect on your body and mind, making you feel drowsy.

If you have this amount of alcohol in your body, it will begin to reach toxic levels. Your body will attempt to quickly pass out the alcohol with your urine. However, this will leave you feeling badly dehydrated in the morning, which, in turn, may cause a severe headache.

The excess amount of alcohol in your system can also upset your digestive system, leading to symptoms of nausea, vomiting, diarrhoea, and indigestion.

More than 10 standard drinks

Drinking more than 10 standard drinks of alcohol will place you at a high risk of developing alcohol poisoning, particularly if you are drinking a lot in a short space of time. It usually takes the liver about one hour to remove one standard drink of alcohol from the body.

Alcohol poisoning occurs when excessive amounts of alcohol begin to interfere with the automatic functions of your body such as:

your breathing

your heart rate

your gag reflex - which prevents you from choking

Alcohol poisoning can result in coma and death.

Short-term risks of alcohol misuse

The short-term risks of alcohol misuse include:

accidents and injury - it is estimated that 70% of all visits to accident and emergency (A&E) departments at peak times are due to alcohol misuse

involvement in violence and antisocial behaviour - in Ireland each year, many violent incidents are linked to alcohol misuse

practicing unsafe sex - which can lead to unplanned pregnancies and sexually transmitted infections (STIs)

loss of personal possessions - many people lose personal possessions, such as their wallet or phone, when they are drunk

unscheduled time off work or college - which could put your education, or job, at risk

Long-term effects of alcohol misuse

If you drink hazardous amounts of alcohol for many years, the cumulative effect of the alcohol will have a toxic effect on many of your body's organs, which may result in organ damage.

The organs that are known to be damaged by long-term alcohol misuse include:

the brain

the liver

the pancreas

Heavy drinking can also increase your blood pressure and your blood cholesterol levels, both of which are major risk factors for heart attacks and strokes.

Long-term alcohol misuse can weaken your immune system, making you more vulnerable to serious infection. It can also weaken your bones, placing you at greater risk of fracturing, or breaking, them.

Alcohol poisoning

The symptoms of alcohol poisoning include:

confusion

vomiting

seizures (fits)

slow breathing (less than eight breaths a minute)

pale, bluish skin

cold and clammy skin

unconsciousness (from which the person cannot be roused)

If you suspect alcohol poisoning, you should dial 999 and ask for an ambulance.

While you are waiting for the ambulance to arrive you should:

not try to make the person vomit, as their gag reflex will be impaired, which means that they could choke on their own vomit

turn the person on to their side and place a cushion under their head in order to help prevent them choking on their own vomit

If someone loses consciousness after drinking alcohol, you should never leave them alone to ‘sleep it off’, even if they appear to be breathing normally. The levels of alcohol in a person’s blood can continue rising for up to 30-40 minutes after a person’s last drink, and this could cause their symptoms to suddenly worsen.

Hazardous drinking

If you are concerned that you are drinking hazardous amounts of alcohol it is likely that you will be referred to a short counselling session, known as a brief intervention.

You may also be invited to a brief intervention if you experience an alcohol-related injury or illness, which could suggest your drinking is at hazardous levels.

A brief intervention lasts around 10-15 minutes and usually consists of a series of steps.

Firstly, the counsellor will provide feedback on the short-term and long-term risks associated with your individual pattern of drinking, while emphasising that it is your responsibility to reduce that risk.

Then the counsellor will provide advice on ways you can reduce your alcohol consumption. For example, you may be told to keep a 'drink diary' so you can accurately record how many standard drinks of alcohol you drink a week, and then try to lower the amount.

If most of your drinking is done on a social basis, the counsellor can provide advice on how you can continue to socialise while reducing your alcohol consumption, such as alternating alcohol with soft drinks, or choosing low-alcohol drinks such as spritzers or low-strength lager.

Then the counsellor will discuss what additional support is available for you if you require it, such as self-help groups or specialist alcohol services.

The session will end with the counsellor discussing any emotional issues you may feel about trying to reduce your drinking, such as apprehension or anxiety, while providing support about how to cope better with these emotions.

Harmful drinking

If you are drinking harmful amounts of alcohol you will first have to make the decision whether you want reduce your alcohol intake to a moderate level (moderation) or quit alcohol altogether (abstinence).

Obviously, abstinence will have a greater health benefit, though often moderation is a more realistic goal, or at least, a first step on the way to abstinence.

Ultimately the choice is yours, though there are circumstances where abstinence is strongly recommended. These are:

if you have liver damage

if you have other medical problems that can be made worse by drinking, such as heart trouble

if you are taking medication that can react badly or unpredictably with alcohol, such as antipsychotics

if you are pregnant or are planning to become pregnant

Abstinence may also be recommended if you have previously tried to achieve moderation and failed.

If you do choose moderation as a treatment goal you will usually be referred to a counselling session that is known as an extended brief intervention. This is similar to a brief intervention, but slightly longer and more in-depth.

You will probably be asked to attend further sessions so your progress can be monitored and further treatment and advice provided if necessary.

You may also receive regular blood tests so the state of your liver can be carefully monitored.

See below for information on available treatments to achieve abstinence.

Dependent drinking

As with harmful drinking, you will need to choose between moderation and abstinence.

Moderation may be a realistic goal for people with mild to moderate dependency. Abstinence would usually be recommended for people with moderate to severe dependency.

Treatment to achieve moderation is carried out in much the same way as for harmful drinking.

Whatever your level of dependency, it is recommended that you spend a period of time free from alcohol, so your body can recover from its effects, and, in cases of moderate to severe dependency, you can break the cycle of drinking alcohol to avoid withdrawal symptoms. This is known as detoxification or 'detox'.

Detoxification

How and where you attempt detoxification will be determined by your level of alcohol dependency.

If your level of dependency is low to moderate you should be able to detox at home without the use of medication, as your withdrawal symptoms should be mild.

If your level of dependency is moderate to severe and your consumption of alcohol is high (over 20 standard drinks a day) and/or you have previously experienced withdrawal symptoms, you should be able to detox at home though you will be given the option of taking medication to help ease withdrawal symptoms. A tranquiliser called chlordiazepoxide is usually used for the purpose.

If your levels of dependency are severe it is usually recommended that you are admitted to a hospital or clinic to detox. This is because there is a risk you could experience more-severe withdrawal symptoms, such as seizures and hallucinations, and may require specialist treatment.

You will find that the withdrawal symptoms are at their worst for the first 48 hours. The symptoms should then gradually improve as your body begins to adjust to being without alcohol. This usually takes between three and seven days from the time of your last drink.

You will also find that your sleep is disturbed - you may wake often during the night, or have problems going to sleep. This is to be expected, and your sleep patterns should return to normal within a month.

During detox you should drink plenty of fluids - approximately three litres a day. Avoid drinking excessive amounts of tea or coffee as this can make sleep problems worse and cause feelings of anxiety. Water or fruit juice would be a better choice.

You should try to eat regular meals even if you are not feeling hungry. Your appetite will return gradually.

If you are taking medication to ease withdrawal symptoms, then you should not drive or operate heavy machinery as the medication will probably make you feel drowsy. Only take your medication as directed.

Detox can be a stressful time. Ways you can try to relieve stress include listening to music, going for a walk or taking a bath.

Abstinence

There are a number of different treatment options available to help you achieve abstinence. Treatment options often differ in effectiveness depending on the individual, so if you feel that a certain treatment option is not working for you, then you should discuss alternative options with your care team and/or your GP.

Medication

There are currently two licensed medications that can be used in the treatment of alcohol misuse:

acamprosate

disulfiram

Acamprosate

Acamprosate (brand name Campral) is used to help prevent relapse in people who have successfully achieved abstinence from alcohol. Acamprosate is usually used in combination with counselling.

Acamprosate works by affecting levels of a chemical in the brain known as gamma-amino-butyric acid (GABA). GABA is thought to be partially responsible for inducing a craving for alcohol.

Side effects of acamprosate include:

nausea

vomiting

itchy skin

Disulfiram

Disulfiram (brand name Antabuse) is a medication that can be used if you are trying to achieve abstinence but are concerned that you may relapse, or have experienced previous relapses.

Disulfiram works by causing a series of extremely unpleasant physical reactions if you drink any alcohol, such as:

nausea

chest pain

vomiting

dizziness

The unpleasantness associated with these reactions should deter you from drinking any more alcohol.

Aside from alcoholic drinks, it is important to avoid all sources of alcohol as these could also induce an unpleasant reaction. Products that may contain alcohol include:

aftershave

mouthwash

some types of vinegar

perfume

You should also steer clear of substances that give off alcoholic fumes, such as paint thinners and solvents.

You will continue to experience unpleasant reactions if you come into contact with alcohol for a week after you finish taking disulfiram, so it is important to maintain your abstinence during this time.

Side effects of disulfiram include:

drowsiness

fatigue

nausea

bad breath

Counselling

Self-help groups

Many people with a dependence on alcohol find it useful to attend self-help groups, the best known of which is Alcoholics Anonymous.

Alcoholics Anonymous believes that alcoholic dependence is a chronic and progressive incurable disease for which total abstinence is the only solution.

Alcoholics Anonymous is based on a programme of 12 steps designed to help overcome addiction, and which include the following points:

you admit that you are powerless over alcohol and your life has become unmanageable

you recognise that you need a power greater than yourself to restore your strength

you examine past errors in your life with the help of a sponsor (an experienced member of the group)